Urology
Discharges * Advance male sling * ARTIFICIAL URETHRAL SPHINCTER IMPLANT * BRACHY * CRYOABLATION * CYSTECTOMY WITH ILEAL LOOP * Cystectomy with Neobladder * Laparoscopic nephrectomy * Laparoscopic partial nephrectomy * OPEN NEPHRECTOMY * Open Partial Nephrectomy * Open Prostatectomy * Pelvic Lymph Node Dissection * Penile prosthesis implant * Percutaneous Nephrostomy Tube * PROSTATECTOMY Robot * TURBT * TURP * VAGINAL SLING * Retroperitoneal Lymph Node Dissection Day Surgery Prescriptions 1. Pyridium 100mg #12 sig: 1 tid prn for bladder discomfort/burning with urination. Under instructions please include…will turn urine orange 2. Oxycodone 5mg #25 sig: 1-2 q 4hours prn pain. Under instructions please include…Do not drive while taking this medicine 3. Colace 100mg #30 sig: 1 bid. Under instructions please include…take along with narcotic pain medicine to avoid constipation *Day surgery specifics: Pyridium needed only if ureteral/bladder involvement in the procedure which is most cases unless scrotal surgery such as vasectomy, or penile surgery such as circumcision. Oxycodone (remember to check for allergies)… for most patients write oxycodone 5mg #25. For circumcision dispense #45. ** For patients over 65: oxycodone 5mg #15 ½-1 q6hr prn pain or ½ vicodin or Tylenol #3 . ***Colace… always order along with narcotic pain medicine. Please ask the resident assigned to the case if you have questions regarding appropriate scripts. Outside Calls When covering the 17000 pager, it is your responsibility to return pages from outpatients. • Do not forward these pages to your senior • Look up the patient's history, call back the patient, and triage the situation appropriately. • Of course, you should always call the Urology back up call person if you feel uncomfortable with the patient's situation after you've done the above and considered the points below. • If you are in the middle of coding a patient or something that means you cannot return the phone call in a reasonable amount of time, you can call the Urology back up person. This should rarely happen. Here are some tips for handling these calls: In general, patients (and ER attendings from OSH) will call you because they are concerned or scared and they do not know what to do. They want a physician's opinion. Most questions are general, and you can use your general medical knowledge to help them. For instance, if patients are having severe pain not improved with pain medication, fevers >101.5, nausea/vomiting, inability to urinate, they need to seek medical attention. Look up the patient on LMR then call back the patient. Record the patients name, date of birth/MRN, details of symptoms, and name of their Attending. If the patient is having concerning symptoms, please FYI email the patient's attending with the details of the conversation and how you handled the call. If you think the patient will need to come to the ED at BWH and will likely need to get admitted to Urology, you should discuss with the senior on call BEFORE having the patient come in. You can include in your email to attending that you discussed it with your senior to cover yourself. HEMATURIA: You will get called about hematuria a lot. It is normal for patients to have hematuria for up to several weeks after a TURBT (transurethral resection of a bladder tumor) or after a TURP (transurethral resection of the prostate) If they are having hematuria, it is not an emergency that requires the patient to be urgently seen at that moment unless the following are true: • They were passing clots and have not been able to urinate for several hours (clot urinary retention) • They recently had a RADICAL PROSTATECTOMY and their catheter is not draining (they should come to BWH ED if possible- no one other than a Urology resident/Urologist should manipulate the catheter) • They recently had a PARTIAL NEPHRECTOMY and they have developed new hematuria (can be a sign of pseudoanyersm or fistula, which can be an emergency due to potential for high blood loss quickly) • They have CP/SOB/Dizziness/Lightheadedness or other signs of anemia from blood loss WOUND OPENING: Chromic stitches start to dissolve at 1-3 weeks. If a superficial wound opens, the patient can use band aid with bacitracin or steri strips to approximate the wound and call clinic in the morning. If fascia is open, T>101.5, excessive bleeding, you should call your senior back-up. PAIN: Do not give narcotics over the phone. Based on surgery, tylenol (500mg po q4h) and motrin (600mg po q6h) is ok. Recent partial nephrectomies, pts with bleeding or renal dysfunction, should not get motrin DYSURIA: Rule out UTI by obtaining UCx (if possible) and may give antibiotics empirically if symptoms of UTI. If not UTI, pyridium 100mg po TID PRN if no renal failure or liver dysfunction. Mitomycin prescriptions In December 2009, Michaella and Steve W. made arrangements with the pharmacy so that we can order Mitomycin ahead of time for our patients. When the Chief resident makes out the assignments, the patients who need Mitomycin are highlighted in yellow. -Rx''' Mitomycin C 40mg''' (Instruction: "40mg in 40mL of NS in a 60cc catheter tip syringe, to be administered intravesically by the MD on on XX/XX/2011 (OR XX)") -prescriptions can be dropped off at the L2 main pharmacy or faxed to 617-732-7499 at least a day in advance. -Please send an email to BWHrxhemonc (at) partners.org. so that they know to expect a script. -May tube to station 13 on day of proceedure if unable to fax Rx day prior. (Pharmacy prefers that we fax the script).